BACKGROUND AND OBJECTIVES The effects of local anesthetics (LA) on neuromuscular transmission and their influence on the neuromuscular blockade produced by competitive neuromuscular blockers have not been fully investigated. The objective of this study was to evaluate, in vitro, the effects of lidocaine and 50% enantiomeric excess bupivacaine (S75-R25) on the neuromuscular blockade produced by ...

Results from in vitro experiments, using the hypogastric nerve--vas deferens preparation, and the phrenic nerve--hemidiaphragm preparation of the guineapig, have been used to determine the separation between the neuromuscular and ganglionic blocking effects of atracurium and tubocurarine. Regression lines were used to calculate the concentrations of each drug (99% confidence limits) which would...

We report on an anesthetic experience with a 74-year-old female with Isaacs' syndrome, who underwent elective surgery for open rotator cuff repair. Isaacs' syndrome is a rare peripheral motor neuron disorder with clinical manifestations such as involuntary muscle twitching, cramps, mild weakness and increased sweating. To avoid prolonged neuromuscular blockade, the patient was observed with neu...

One of the challenges during the perioperative care of patients with myotonic dystrophy is the reversal of neuromuscular blocking agents. Agents that inhibit acetylcholinesterase, such as neostigmine, may precipitate myotonia, and are therefore relatively contraindicated. Sugammadex is a novel pharmacologic agent, which encapsulates rocuronium or vecuronium, thereby reversing their effect. We r...

The use of atracurium during major abdominal surgery was assessed in 20 infants with hepatic dysfunction caused by biliary atresia. An initial dose of 0.6 mg kg-1 provided excellent intubating conditions in all patients. Subsequent neuromuscular blockade was monitored with a peripheral nerve stimulator and incremental doses of atracurium were given on reappearance of a single twitch. Neuromuscu...

Closed-loop control of neuromuscular blockade, using a semi-continuous infusion of vecuronium, is described. In 28 patients, the average neuromuscular transmission was between 13 and 17% of control. Requirements for vecuronium averaged 1.1 micrograms kg-1 min-1 (0.8-1.5 micrograms kg-1 min-1), being in the same range as for repeated bolus injections. No side effects were observed. After the inf...

Multiple searches were carried out in the PubMed database to identify articles with better methodological design, followed by critical evaluation of their contents and classification according to the strength of evidence. According to the recommendations of the Oxford Centre for Evidence Based Medicine, literature systematic reviews and randomized clinical trials were preferred. Searches were c...